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Navigating the billing process for Applied Behavior Analysis (ABA) therapy can be complex, especially with the numerous CPT codes practitioners must understand and apply. This guide breaks down the key CPT codes for 2024, offering detailed descriptions of each code to help ensure accurate billing and maximize reimbursement.
Current Procedural Terminology (CPT) codes are standardized codes used to describe medical, surgical, and diagnostic services. For ABA therapy, these codes are critical for communicating the services provided to insurance companies, facilitating accurate billing and timely reimbursement.
CPT codes for ABA therapy are categorized into two main sections: Category I and Category III. Below is a breakdown of these codes along with their descriptions.
These codes represent established and recognized ABA services, such as assessments, individual and group interventions, and family-based interventions. Notably, codes 97155-97157 have been updated to allow for telehealth billing.
These codes address more specific ABA services, including the assessment of adaptive behavior and technician-delivered treatment with protocol modifications.
Keeping up with ABA billing codes and preparing accurate health insurance billing is no easy feat. Besides CPT codes being hard to master, they keep on changing over the years.
Simple clerical errors like making wrong entries or submitting illegible documentation can lead to a patient’s insurance denying a claim. The result is delayed payment or lost revenue.
If you would like to improve the accuracy and efficiency of your ABA billing system, use the following tips.
Once you’ve prepared a well-documented claim, you need to send it to the payer on paper or electronically. Ensure you have the correct mailing address or submit a soft copy through your electronic health record (EHR) system, practice management software (PMS)/clearinghouse, or insurer’s website.
Apart from the client’s name, some of their demographic details like age and gender are necessary to complete a claim form. Double-check your client’s data to avoid errors that could lead to a claim denial or delay.
It is imperative to check verification of benefits, with an understanding if there is a pre-determination or prior authorization required before treatment begins. Before submitting claims, check the client’s insurance policy status to determine their eligibility for coverage. It will save you the disappointment of a claim denial due to a client having exhausted their coverage cap.
Sometimes you’ll need to verify vital details like a client’s insurance number. Instead of calling them, make a copy of their insurance card for your review when needed. If you have practice management software, their info should be stored in your digital records for easy access.
Most health insurance companies offer a 60 to 90-day allowance for claim submission. Confirm the deadline for various providers and file your claims on time. If a claim is denied and your practice must resubmit, be aware of any deadlines for this process as well.
While the tips above can help minimize errors and ensure smoother claim submissions, consider incorporating automated billing software into your ABA practice. This software reduces errors, improves efficiency, speeds up reimbursements, enhances claim tracking, and offers integrated reporting. It can significantly enhance your billing accuracy, efficiency, and overall financial health.
AlohaABA’s comprehensive practice management software includes automated billing that integrates directly with other areas of your practice, such as scheduling, documentation, and session notes. If you want to improve your practice’s billing process, try AlohaABA free for 30 days to see how it can help. Additionally, our managed billing services can further streamline your billing processes and ensure your practice gets paid accurately and on time.